When the conditions in DI 11055.065 through DI 11055.095 are met, the FO fully prepares the SSA-831. Complete Items 1 through 14 in accordance with DI 11055.130 along with the items indicated below:

Item 16 - Diagnosis

Enter “None established.”

Item 19A - Claimant Not Disabled Through Date of Current Determination

Always check block “A.”

Item 20 - Vocational Background

Complete this item only in Title II (Disability Benefits (DIB), Disabled Widow(er) Benefits (DWB), DWB Medicare-Only, DIB Freeze, and Childhood Disability Benefits (CDB)) cases.

Item 22 -- Reg. Basis Code

Enter denial code N33-920(b) for Title XVI SGA denials.

Item 24 - Mob. Code

Determine the mobility status by referring to the disability background information contained on the SSA-3820 (Disability Report – Child) or SSA-3368 (Disability Report – Adult), SSA-3369 (Work History Report), function reports, or any other (later) information recorded in file.

Enter one of the following codes, which reflect the claimant’s mobility status at the time the SSA-831 is prepared:

A- Confined in a medical institution other than a general hospital

B- Patient in a general hospital

C- Confined in bed at home

D- Confined in a chair (including wheel chair)

E- None of the above, but unable to go outside

F- Able to go outside, but only with the help of another person or device

G- Able to go outside without help

M- Claimant is deceased

Item 26 - List No.

See DI 33530.000 - Index of Disability-Related List Code Numbers (Table of Contents).

Item 27 - Rationale

See DI 26515.000 - Rationale Preparation (Initial Claims) (Table of Contents).

Item 29 - Ltr./Par. No.

Complete this item in accordance with Preparing Notices in Disability Claims DI 11010.345.

Item 37 - SSA Representative

The claims representative or other designated FO employee signs his or her name.

Item 38 - Date

Enter the date the SSA-831 is signed by the claims representative or other designated FO employee.